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"My heart feels like it's racing"

57 yo male with history of hypertension presents to the hospital with persistent "heart racing" and shortness of breath with exertion. He is a healthy, athletic man who was in his normal state of health until about 1 week ago when he began feeling "off." He states that he first noticed his typical workouts were a lot more difficult. Initially he thought he was just out of shape, but the symptoms persisted. He was in California for a week with his family prior to the start of this.

Over the past 2 days his symptoms have gotten worse. He feels like his heart races with minimal exertion, and his breathing is significantly worse. He takes amlodipine for his blood pressure and no other medications or over the counter drugs. He has no family history of cancer or blood clots, his father died at 81 from heart disease. Denies any leg swelling, chest pain, nausea or vomiting. No fevers or cough. He presents to the emergency room on day 7 of his symptoms.


T 98.2 HR 108 (125 with minimal exertion) BP 110 / 76 SPO2 95% on room air RR 18


Gen: In no distress, appears comfortable at rest

CVD: tachycardic, no murmurs

Lungs: clear bilaterally; no wheezing

ABD: soft, nontender

Extremities: No edema or unilateral swelling


WBC 13, Hemoglobin 13, Platelet 200k

Cr 0.8, BUN 25

Troponin 0.04, Lactate 1.0, BNP 200

LFTs unremarkable

EKG: Sinus tachycardia

CXR: unremarkable






Parasternal Long

Parasternal Short

Other cardiac views were technically difficult and not obtained


Right Common Femoral / Greater Saphenous Junction

R Femoral

Left Femoral

Left Popliteal

What is the Diagnosis? How do you manage this condition?

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